Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia

Gustavo Oderich, Tiziano Tallarita, Peter Gloviczki, Audra A. Duncan, Manju Kalra, Sanjay Misra, Stephen Cha, Thomas C. Bower

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Abstract

Objective: The purpose of this study was to describe the incidence, management, and outcomes of mesenteric artery complications (MACs) during angioplasty and stent placement (MAS) for chronic mesenteric ischemia (CMI). Methods: We retrospectively reviewed the clinical data of 156 patients treated with 173 MAS for CMI (1998-2010). MACs were defined as procedure-related mesenteric artery dissection, stent dislodgement, embolization, thrombosis, or perforation. End points were procedure-related morbidity and death. Results: There were 113 women and 43 men (mean age, 73 ± 14 years). Eleven patients (7%) developed 14 MACs, including distal mesenteric embolization in six, branch perforation in three, dissection in two, stent dislodgement in two, and stent thrombosis in one. Five patients required adjunctive endovascular procedures, including in two patients each, catheter-directed thrombolysis or aspiration, retrieval of dislodged stents, and placement of additional stents for dissection. Five patients (45%) required conversion to open repair: two required evacuation of mesenteric hematoma, two required mesenteric revascularization, and one required bowel resection. There were four early deaths (2.5%) due to mesenteric embolization or myocardial infarction in two patients each. Patients with MACs had higher rates of mortality (18% vs 1.5%) and morbidity (64% vs 19%; P <.05) and a longer hospital length of stay (6.3 ± 4.2 vs 1.6 ± 1.2 days) than those without MACs. Periprocedural use of antiplatelet therapy was associated with lower risk of distal embolization or vessel thrombosis (odds ratio, 0.2; 95% confidence interval, 0.06-0.90). Patients treated by a large-profile system had a trend toward more MACs (odds ratio, 1.8; 95% confidence interval, 0.7-26.5; P =.07). Conclusions: MACs occurred in 7% of patients who underwent MAS for CMI and resulted in higher mortality, morbidity, and longer hospital length of stay. Use of antiplatelet therapy reduced the risk of distal embolization or vessel thrombosis. There was a trend toward more MACs in patients who underwent interventions performed with a large-profile system.

Original languageEnglish (US)
Pages (from-to)1063-1071
Number of pages9
JournalJournal of Vascular Surgery
Volume55
Issue number4
DOIs
StatePublished - Apr 2012

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Mesenteric Arteries
Angioplasty
Stents
Length of Stay
Thrombosis
Dissection
Morbidity
Odds Ratio
Mesenteric Ischemia
Confidence Intervals
Endovascular Procedures
Mortality
Hematoma
Catheters
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. / Oderich, Gustavo; Tallarita, Tiziano; Gloviczki, Peter; Duncan, Audra A.; Kalra, Manju; Misra, Sanjay; Cha, Stephen; Bower, Thomas C.

In: Journal of Vascular Surgery, Vol. 55, No. 4, 04.2012, p. 1063-1071.

Research output: Contribution to journalArticle

Oderich, Gustavo ; Tallarita, Tiziano ; Gloviczki, Peter ; Duncan, Audra A. ; Kalra, Manju ; Misra, Sanjay ; Cha, Stephen ; Bower, Thomas C. / Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia. In: Journal of Vascular Surgery. 2012 ; Vol. 55, No. 4. pp. 1063-1071.
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abstract = "Objective: The purpose of this study was to describe the incidence, management, and outcomes of mesenteric artery complications (MACs) during angioplasty and stent placement (MAS) for chronic mesenteric ischemia (CMI). Methods: We retrospectively reviewed the clinical data of 156 patients treated with 173 MAS for CMI (1998-2010). MACs were defined as procedure-related mesenteric artery dissection, stent dislodgement, embolization, thrombosis, or perforation. End points were procedure-related morbidity and death. Results: There were 113 women and 43 men (mean age, 73 ± 14 years). Eleven patients (7{\%}) developed 14 MACs, including distal mesenteric embolization in six, branch perforation in three, dissection in two, stent dislodgement in two, and stent thrombosis in one. Five patients required adjunctive endovascular procedures, including in two patients each, catheter-directed thrombolysis or aspiration, retrieval of dislodged stents, and placement of additional stents for dissection. Five patients (45{\%}) required conversion to open repair: two required evacuation of mesenteric hematoma, two required mesenteric revascularization, and one required bowel resection. There were four early deaths (2.5{\%}) due to mesenteric embolization or myocardial infarction in two patients each. Patients with MACs had higher rates of mortality (18{\%} vs 1.5{\%}) and morbidity (64{\%} vs 19{\%}; P <.05) and a longer hospital length of stay (6.3 ± 4.2 vs 1.6 ± 1.2 days) than those without MACs. Periprocedural use of antiplatelet therapy was associated with lower risk of distal embolization or vessel thrombosis (odds ratio, 0.2; 95{\%} confidence interval, 0.06-0.90). Patients treated by a large-profile system had a trend toward more MACs (odds ratio, 1.8; 95{\%} confidence interval, 0.7-26.5; P =.07). Conclusions: MACs occurred in 7{\%} of patients who underwent MAS for CMI and resulted in higher mortality, morbidity, and longer hospital length of stay. Use of antiplatelet therapy reduced the risk of distal embolization or vessel thrombosis. There was a trend toward more MACs in patients who underwent interventions performed with a large-profile system.",
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AU - Oderich, Gustavo

AU - Tallarita, Tiziano

AU - Gloviczki, Peter

AU - Duncan, Audra A.

AU - Kalra, Manju

AU - Misra, Sanjay

AU - Cha, Stephen

AU - Bower, Thomas C.

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N2 - Objective: The purpose of this study was to describe the incidence, management, and outcomes of mesenteric artery complications (MACs) during angioplasty and stent placement (MAS) for chronic mesenteric ischemia (CMI). Methods: We retrospectively reviewed the clinical data of 156 patients treated with 173 MAS for CMI (1998-2010). MACs were defined as procedure-related mesenteric artery dissection, stent dislodgement, embolization, thrombosis, or perforation. End points were procedure-related morbidity and death. Results: There were 113 women and 43 men (mean age, 73 ± 14 years). Eleven patients (7%) developed 14 MACs, including distal mesenteric embolization in six, branch perforation in three, dissection in two, stent dislodgement in two, and stent thrombosis in one. Five patients required adjunctive endovascular procedures, including in two patients each, catheter-directed thrombolysis or aspiration, retrieval of dislodged stents, and placement of additional stents for dissection. Five patients (45%) required conversion to open repair: two required evacuation of mesenteric hematoma, two required mesenteric revascularization, and one required bowel resection. There were four early deaths (2.5%) due to mesenteric embolization or myocardial infarction in two patients each. Patients with MACs had higher rates of mortality (18% vs 1.5%) and morbidity (64% vs 19%; P <.05) and a longer hospital length of stay (6.3 ± 4.2 vs 1.6 ± 1.2 days) than those without MACs. Periprocedural use of antiplatelet therapy was associated with lower risk of distal embolization or vessel thrombosis (odds ratio, 0.2; 95% confidence interval, 0.06-0.90). Patients treated by a large-profile system had a trend toward more MACs (odds ratio, 1.8; 95% confidence interval, 0.7-26.5; P =.07). Conclusions: MACs occurred in 7% of patients who underwent MAS for CMI and resulted in higher mortality, morbidity, and longer hospital length of stay. Use of antiplatelet therapy reduced the risk of distal embolization or vessel thrombosis. There was a trend toward more MACs in patients who underwent interventions performed with a large-profile system.

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